| NPI | 1679675854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR DO172963) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 1948) |
| 207P00000X Emergency Medicine (Licence: NC 200400681) | |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2023-02-14 |